Adult patients with advanced non-Hodgkin's lymphoma in whom conventional chemotherapy has failed are seldom cured thereafter. We studied 100 such patients with intermediate-grade or high-grade non-Hodgkin's lymphoma who were subsequently treated with high-dose chemotherapy (61 patients) or high-dose chemotherapy plus total-body irradiation (39 patients), with bone marrow transplantation used for hematologic support. Thirty-four patients had disease that had been refractory to primary chemotherapy, and 66 patients had had a complete remission with primary chemotherapy but later relapsed. Before autologous bone marrow transplantation and high-dose chemotherapy, the 66 relapsed patients had also received conventional salvage chemotherapy; 22 had had no response or had had disease progression (a response termed "resistant relapse"), and 44 patients had responded partially or completely (a response termed "sensitive relapse"). After high-dose therapy and bone marrow transplantation, the actuarial three-year disease-free survival was zero in the refractory group, 14 percent in the resistant-relapse group, and 36 percent in the sensitive-relapse group. Patients who had had a complete remission in response to initial chemotherapy had a higher disease-free survival rate than those who had not (P less than 0.001), and patients with sensitive relapse had a higher disease-free survival rate than those with resistant relapse (P less than 0.003). These results should be considered in the planning or interpretation of trials of salvage chemotherapy in adults with non-Hodgkin's lymphoma.
The optimum treatment of primary CNS lymphoma (PCNSL) is not yet determined. The objective of this study was to assess the safety and efficacy of initial methotrexate-based chemotherapy followed by high-dose chemotherapy (HDT) with autologous stem cell transplantation (ASCT) in patients with newly diagnosed PCNSL. Twenty-five patients received two courses of initial chemotherapy combining methotrexate, etoposide, carmustine and methylprednisolone, and one course of ifosfamide-cytarabine followed by peripheral stem cell collection. Seventeen responsive patients then received HDT using carmustine, etoposide, cytarabine and melphalan with autologous stem cell rescue. After ASCT for responding patients or after salvage therapy for non-responders, whole brain radiation therapy at a dose of 30 Gy was delivered. The objective response rate to the induction chemotherapy was 84%. Four of the 21 responding patients did not have ASCT because of toxicity or refusal. With a median follow-up time of 34 months, the projected event free survival rate is 46% at 4 years. Projected overall survival is 64% at 4 years. Sixteen patients are actually in continuous complete response. No evidence of late treatment-related toxicity was observed. This treatment approach appears feasible in newly diagnosed PCNSL with encouraging results.
Summary:second line regimen (1 factor) and more intensive treatments for the bad prognosis group (2 factors). High-dose therapy with autologous stem cell transplanKeywords: Hodgkin's disease; relapse; high-dose tation (ASCT) has been widely proposed for patients therapy; autologous bone marrow transplantation with relapsed Hodgkin's disease (HD). From 1982 to 1993, we selected (from the French registry for bone marrow transplantation) 280 patients, who underwent ASCT for relapsed HD after initial treatment includingThe majority of patients with Hodgkin's disease (HD) can chemotherapy. Patient characteristics at diagnosis were:be cured by conventional doses of chemotherapy and/or sex ratio (M/F): 1.5; median age: 30 years (5-59 years), radiotherapy. 1,2 According to known prognostic factors at stage I, II: 43%; III, IV: 57%; 32% had chemotherapy, diagnosis (age, erythrocyte sedimentation rate, B-symp-68% chemo؉ radiotherapy. All patients achieved comtoms, mediastinal mass, extranodal involvement, hemogloplete remission after first-line therapy and subsequently bin, lactate dehydrogenase (LDH)), 3,4 10-40% of patients relapsed. The median interval between diagnosis and with HD who achieve complete remission (CR) after initial high-dose therapy was 34 months. First relapse treatment will relapse. 5,6 Long-term outcome after a first occurred in 78% of the patients at a median end-ofrelapse remains poor with survival below 50%, especially treatment to relapse time of 18 months. All patients in patients with a time from primary treatment to failure received salvage chemotherapy before high-dose therless than 1 year. 7 The role of high-dose therapy with autoapy, and the median time between relapse and highlogous hematopoietic stem cell transplantation (ASCT) has dose therapy was 5 months. After this regimen, 84%been widely investigated in patients with refractory or of the patients were considered to have chemosensitive relapsing HD. [8][9][10][11] High-dose therapy in this setting is assorelapse. Conditioning regimens were: BEAM: 60%; ciated with higher CR rates and progression-free survivals CBV/BEAC: 26%. Transplant-related mortality was ranging from 30 to 50%. A randomized study by the British 6%. With a median follow-up of 3 years after high-dose National Lymphoma Investigation group has demonstrated therapy, overall and progression-free survivals at 4 a clear advantage in terms of event-free survival in favor years were, 66 and 60%, respectively. Neither the conof high-dose therapy compared to conventional-dose treatditioning regimen nor the stem cell source affected surment. 12 vival. Good prognostic factors for survival were: chemoDespite all these studies, it remains difficult to know sensitivity of relapse (P Ͻ 0.001) and first relapse vs whether all patients with relapsing HD will benefit signififurther relapse (P Ͻ 0.05). For 214 patients in first cantly from such intensive approaches and most reports in relapse, other significant factors for survival were: endthis context have included heterogeneous grou...
Purging of bone marrow in ABMT for NHL does not affect the rate of hematologic engraftment or risk of procedure-related death (PRD). There is no significant difference in PFS for patients whose bone marrow is purged as compared with unpurged.
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